Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Delusions

The shared delusions: When doing a history and physical, a rudimentary “psych” history is obtained. This is intended to rule out blatant and obvious psychopathology. It tells us very little about the patient. Indeed, our focus is limited to the patient’s chief chief complaint. As an injured worker passes through the paths of occupational medicine to physical therapies to specialist referrals, little more is known about the patient other than the diagnostic studies are negative and/or do not account for the degree and nature of the patient’s subjective complaints.

Patients may remain in the system for years without ever revealing, or being asked about, the nature of their lives, developmental history and the range of joys and frustrations that have characterized their existence. Patients, in turn, feel that nurses, case managers, attorneys, and adjustors should have a greater appreciation of their plight. All are, in the minds of the patient, insensitive and noncompassionate. Patients rarely think of those involved in their care as having lives…and difficulties…of their own. This becomes their delusions.

Patients often function as though checks are not sent, procedures denied, medications not authorized or referrals delayed only for them. In their misery that no one seems to see their unique problems, they maintain that they are somehow concurrently unique in the obstacles they encounter.

Patients note, unfortunately with too much accuracy, that clinicians treat their complaints without a full appreciation of their severity. Or as one surgeon said to a patient recently “the fact that you still take Dilaudid is more of a concern to me than the fact that there is no bone growth at the site of your fusion.” We feel that patients began to exist at the moment of trauma. Patients believe that we do not exist outside of the role to meet the immediacy of their needs. These are our shared delusions.

Perhaps these shared delusions arose from our creating clinics of massive rows of chairs or arose because of inordinate delay in emergency departments and in waiting rooms. Perhaps it arose because we have little time. Or perhaps this gulf between patients and everyone else, including family, arose because we simply do not have a full understanding of their lives…nor they of ours.